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Sustanon 250, 250mg/ml solution for injection

Last Updated on eMC 03-Jan-2017 View document  | Aspen Contact details

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Updated on 03-Jan-2017 and displayed until Current

Reasons for adding or updating:

  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 10 - Date of revision of the text

Date of revision of text on the SPC: 06-Dec-2016

Legal Category:POM

Black Triangle (CHM): NO

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4.4       Special warnings and precautions for use

Clotting disorders:

 

Testosterone should be used with caution in patients with thrombophilia, as there have been post-marketing studies and reports of thrombotic events in these patients during testosterone therapy.

 

10        DATE OF REVISION OF THE TEXT

06/12/2016  25/03/2015

Updated on 02-Apr-2015 and displayed until 03-Jan-2017

Reasons for adding or updating:

  • Change to section 4.1 - Therapeutic indications
  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.8 - Undesirable effects
  • Change to section 10 - Date of revision of the text

Date of revision of text on the SPC: 25-Mar-2015

Legal Category:POM

Black Triangle (CHM): NO

Free-text change information supplied by the pharmaceutical company:



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4.1       Therapeutic indications

Testosterone replacement therapy for male hypogonadism, when testosterone deficiency has been confirmed by clinical features and biochemical tests.

Testosterone replacement therapy in males for conditions associated with primary and secondary hypogonadism, either congenital or acquired.


4.3 Contraindications
• Pregnancy (see section 4.6).
• Known or suspected carcinoma of the prostate or breast (see section 4.4.).
• Breast-feeding.
• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1, including arachis oil. Sustanon 250 is therefore contraindicated in patients allergic to peanuts or soya (see section 4.4).

4.4       Special warnings and precautions for use

Medical examination:

Testosterone level should be monitored at baseline and at regular intervals during treatment. Clinicians should adjust the dosage individually to ensure maintenance of eugonadal testosterone levels.
Haematocrit and haemoglobin to exclude polycythaemia.

 

In patients receiving long-term androgen therapy, the following laboratory parameters should also be monitored regularly: haemoglobin, and haematocrit, liver function tests and lipid profile.

·      Pre-exisiting conditions  -

In patients with pre existing suffering from severe cardiac, hepatic or renal insufficiency or ischaemic heart disease, treatment with testosterone may cause severe complications characterised by oedema with or without congestive cardiac failure. In such cases treatment must be stopped immediately.

Testosterone may cause a rise in blood pressure and Sustanon 250 should be used with caution in men with hypertension.

Sleep apnoea- Caution should be applied when treating men with sleep apnoea. There have been reports that testosterone can cause or exacerbate pre-existing sleep apnoea

Older People:

There is limited experience on the safety and efficacy of the use of Sustanon 250 in patients over 65 years of age. Currently, there is no consensus about age specific testosterone reference values. However, it should be taken into account that physiologically testosterone serum levels are lower with increasing age.



ACTH or Corticosteroids:

The concurrent administration of testosterone with ACTH or corticosteroids may enhance oedema formation thus therefore these active substances should be administered cautiously, particularly in patients with cardiac or hepatic disease or in patients predisposed to oedema (see section 4.4).

 

Undesirable effects

Due to the nature of Sustanon 250 side effects cannot be quickly reversed by discontinuing medication. Injectables in general, may cause a local reaction at the injection site.

 

The following adverse reactions have been associated with androgen therapy in general.

  Since the undesirable effects described below are derived from post marketing surveillance and based on general androgenic class labelling, the frequency could not be calculated.

 All adverse reactions are listed by system organ class and frequency; common (³ 1/100 to < 1/10) and not known (cannot be estimated from the available data).


System Organ Class

MedDRA term*

Frequency

Neoplasms benign, malignant and unspecified (incl. cysts and polyps)

Prostatic cancer1

Not known

Blood and lymphatic system disorders

Polycythaemia

Not known

Metabolism and nutrition disorders

Fluid retention

Not known

Psychiatric disorders

Depression,

Nervousness

Mood altered

Libido increased,

Libido decreased

 

 

Not known

Vascular disorders

Hypertension

Not known

Gastrointestinal disorders

Nausea

Not known

Hepatobiliary disorders

Hepatic function abnormal

Not known

Skin and subcutaneous tissue disorders

Pruritus

Acne

Not known

 

Musculoskeletal and connective tissue disorders

Myalgia

Not known

Reproductive system and breast disorders

Ejaculation disorder

Gynaecomastia

OligozoospermiaOligospermia

Priapism

Benign prostatic hyperplasia2

 

 

Not known

Investigations

Lipids abnormal3

PSA increased

 

 

Haematocrit increased

Red blood cell count increased

Haemoglobin increased

Not known

 

 

 

Common

 

 

* MedDRA version 175.0

1 Progression of a sub-clinical prostatic cancer

2 Prostatic growth (to eugonadal state)

3 Decrease in serum LDL-C, HDL-C and triglycerides

 

 

 

The terms used to describe the undesirable effects above are also meant to include synonyms and related terms.

 

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

5        PHARMACOLOGICAL PROPERTIES

5.2       Pharmacokinetic properties

Biotransformation:

Testosterone is metabolised to dihydrotestosterone and estradiol, which are further metabolised via the normal pathways.

6        PHARMACEUTICAL PARTICULARS

10      DATE OF REVISION OF THE TEXT

25/03/2015

15/12/2014

Updated on 17-Dec-2014 and displayed until 02-Apr-2015

Reasons for adding or updating:

  • Change to section 5.1 - Pharmacodynamic properties
  • Change to section 6.1 - List of excipients
  • Change to section 6.5 - Nature and contents of container
  • Change to section 6.6 - Special precautions for disposal and other handling
  • Change to section 10 - Date of revision of the text

Date of revision of text on the SPC: 01-Dec-2014

Legal Category:POM

Black Triangle (CHM): NO

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5        PHARMACOLOGICAL PROPERTIES

6        PHARMACEUTICAL PARTICULARS

6.1       List of excipients

Arachis Oil

Benzyl Alcohol Ph.Eur.

Arachis Oil Ph.Eur.

6.5       Nature and contents of container

Each colourless glass ampoule is filled with 1 ml of Sustanon 250.

A box of Sustanon 250 contains 1 ampoule.
Colourless glass ampoule filled with 1 ml of Sustanon in boxes of 1, 3 and 6.

6.6       Special precautions for disposal and other handling

 

10      DATE OF REVISION OF THE TEXT

28/11/15/122014


Updated on 08-Dec-2014 and displayed until 17-Dec-2014

Reasons for adding or updating:

  • Change to section 5.1 - Pharmacodynamic properties
  • Change to section 5.3 - Preclinical safety data
  • Change to section 10 - Date of revision of the text

Date of revision of text on the SPC: 28-Nov-2014

Legal Category:POM

Black Triangle (CHM): NO

Free-text change information supplied by the pharmaceutical company:



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5.1       Pharmacodynamic properties

Pharmacotherapeutic group: Androgens. ATC code G03B A03

Treatment of hypogonadal men with Sustanon 250 results in a clinically significant rise of plasma concentrations of testosterone, dihydrotestosterone, estradiol and androstenedione, as well as decrease of SHBG (Sex hormone binding globulin). Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are restored to the normal range. In hypogonadal men, treatment with Sustanon 250 results in an improvement of testosterone deficiency symptoms. Moreover, treatment increases bone mineral density and lean body mass, and decreases body fat mass. Treatment also improves sexual function, including libido and erectile function. Treatment decreases serum LDL-C, HDL-C and triglycerides and increases haemoglobin and haematocrit, which may lead to polycythaemia. No clinically relevant changes in liver enzymes and PSA have been reported. Testosterone also produces systemic effects, such as increasing the retention of sodium, potassium and chloride leading to an increase in water retention. Treatment may result in an increase in prostate size and PSA levels, and worsening of lower urinary tract symptoms, but no adverse effects on prostate symptoms have been observed. In hypogonadal diabeteic patients, improvement of insulinsensitivity and/or reduction in blood glucose have been reported with the use of androgens. In boys with constitutional delay of growth and puberty, treatment with Sustanon 250 androgens accelerates growth and induces development of secondary sex characteristics. In female-to-male transsexuals, treatment with androgens Sustanon 250 induces masculinisation.



5.3       Preclinical safety data

Non Applicable

Preclinical data with androgens in general reveal no hazard for humans. The use of androgens in different species has been demonstrated to result in virilisation of the external genitals of female foetuses.






10      DATE OF REVISION OF THE TEXT

01/05/2014 28/11/2014

Updated on 24-Oct-2014 and displayed until 08-Dec-2014

Reasons for adding or updating:

  • Change to section 2 - Qualitative and quantitative composition
  • Change to section 4.2 - Posology and method of administration
  • Change to section 4.3 - Contraindications
  • Change to section 4.4 - Special warnings and precautions for use
  • Change to section 4.5 - Interaction with other medicinal products and other forms of interaction
  • Change to section 4.6 - Fertility, pregnancy and lactation
  • Change to section 4.7 - Effects on ability to drive and use machines
  • Change to section 4.8 - Undesirable effects

Date of revision of text on the SPC: 01-May-2014

Legal Category:POM

Black Triangle (CHM): NO

Free-text change information supplied by the pharmaceutical company:



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2        QUALITATIVE AND QUANTITATIVE COMPOSITION

- 30 mg Testosterone propionate                      30mg/ml

- 60 mg Testosterone phenylpropionate           60mg/ml

- 60 mg Testosterone isocaproate                     60mg/ml

- 100 mg Testosterone decanoate                       100mg/ml       

All four components are esters of the natural hormone testosterone.

The (equivalent to a total amount of testosterone per ml is  of 176mg of Testosterone)

Sustanon 250 contains 1ml Arachis oil. For a full list of excipients, see section 6.1.

4.2       Posology and method of administration

 

Posology

Dosage

 

In general, the dosage should be adjusted to the individual  response of the individual patient.

 

Adults (incl. elderly):

Usually, one injection of 1ml per 3 three weeks is adequate.

 

Children Paediatric population:

Safety and efficacy have not been adequately determined in children and adolescents. Pre-pubertal children treated with Sustanon 250 should be treated with caution (see section 4.4).

 

 Method of aAdministration

Sustanon 250 should be administered by dDeep intramuscular injection.

 

4.3.      Contraindications

•             Pregnancy (see section 4.6).

•             Known or suspected carcinoma of the prostate or breast (see section 4.4).

•             Breast-feeding.

•             Hypersensitivity to the active substance or to any of the excipients, including arachis oil.  Sustanon 250 is therefore contraindicated in patients allergic to peanuts or soya (see section 4.4).


4.4       Special warnings and precautions for use

 

Medical examination:

Physicians should consider monitoring patients subjects receiving Sustanon 250 before the start of treatment, at quarterly intervals for the first 12 months and yearly thereafter for the following parameters:
Ddigital rectal examination (DRE) of the prostate and PSA to exclude benign prostate hyperplasia or a sub-clinical prostate cancer (see section 4.3),
Hhematocrit and hemoglobin to exclude polycythemia.

Conditions that need supervision:
Patients, especially the elderly, with the following conditions should be be also monitored for:
Tumours - Mammary carcinoma, hypernephroma, bronchial carcinoma and skeletal metastases. In these patients hypercalcaemia or hypercalciuria may develop spontaneously, also during androgen therapy. The latter can be indicative of a positive tumour response to the hormonal treatment. Nevertheless, the hypercalcaemia or hypercalciuria should first be treated appropriately and after restoration of normal calcium levels, hormone therapy can be resumed.

·      Pre-exisiting conditions - 

 

epilepsy or migraine (or a history of these conditions), since androgens may occasionally induce fluid and sodium retention

skeletal metastases, since androgens may induce hypercalcaemia or hypercalciuria in these patients.

In patients with pre-existing cardiac, renal or hepatic insufficiency/disease or hypertension androgen treatment may cause complications characterized by oedema with or without congestive heart failure. In such cases treatment must be stopped immediately. Patients who experienced myocardial infarction, cardiac-, hepatic- or renal insufficiency, hypertension, epilepsy, or migraine should be monitored due to the risk of deterioration of or reoccurrence of disease. In such cases treatment must be stopped immediately.  

Epilepsy or Migraine - (or a

 

Epilepsy or Migraine - (or a history of these conditions), since androgens may occasionally induce fluid and sodium retention.
Diabetes mellitus – Androgens in general and Sustanon 250 can improve glucose tolerance in diabetic patients (see section 4.5).
Anti-coagulant therapy – Androgens in general and Sustanon 250 can enhance the anti-coagulant action of coumarin-type agents (see also section 4.5). 

·                     Sleep apnea- Caution should be applied when treating men with sleep apnea. There have been reports that testosterone can cause or exacerbate pre-existing sleep apnea. However, there is a lack of evidence regarding the safety of testosterone in men with the condition. Good clinical judgment and caution should be employed in patients subjects with risk factors such as adiposity or chronic lung diseases.

 

Adverse events:
If androgen-associated adverse reactions occur (see section 4.8), treatment with Sustanon 250 should be discontinued and, upon resolution of complaints, resumed with a lower dose.

Virilisation:

Patients should be informed about the potential occurrence of signs of virilisation. In particular, singers and women with speech professions should be informed about the risk of deepening of the voice. The voice changes may be irreversible.

If signs of virilisation develop, the risk/benefit ratio has to be newly assessed with the individual patient.

(Mis) use in sports:

Patients who participate in competitions governed by the World Anti-Doping Agency (WADA) should consult the WADA-code before using this product as Sustanon 250 can interfere with anti-doping testing. The misuse of androgens to enhance ability in sports carries serious health risks and is to be discouraged.

Excipients:

Sustanon 250 contains Arachis oil (peanut oil) and should not be taken / applied by patients known to be allergic to peanut. As there is a possible relationship between allergy to peanut and allergy to soya, patients with soya allergy should also avoid Sustanon 250 (see section 4.3).

Sustanon 250 contains 100 mg benzyl alcohol per ml solution and must not be given to premature babies or neonates. Benzyl alcohol may cause toxic reactions and anaphylactoid reactions in infants and children up to 3 years old.

In pre-pubertal children statural growth and sexual development should be monitored since androgens in general and Sustanon in high dosages may accelerate epihyseal closure and sexual maturation.
If androgen-associated adverse reactions occur, treatment with Sustanon should be discontinued and upon resolution of the complaints resumed with lower dosages.
The misuse of androgens to enhance ability in sports carries serious health risks and is to be discouraged.

Sustanon 250 contains Arachis oil (peanut oil) and should not be taken / applied by patients known to be allergic to peanut. As there is a possible relationship between allergy to peanut and allergy to Soya, patients with Soya allergy should also avoid Sustanon 250.

Sustanon 250 contains benzyl alcohol (0.1 mg benzyl alcohol per ml) and must not be given to premature babies or neonates. Benzyl alcohol may cause toxic reactions and anaphylactoid reactions in infants and children up to 3 years old

Female-to-male transsexual supportive therapy

Before initiating Sustanon 250 for female-to-male transsexuals, specialist assessment should be undertaken, including psychiatric assessment. A complete personal and medical history should be taken. During treatment, periodic check-ups are recommended of a frequency and nature adapted to the individual. The following should be monitored:

            ▪           signs of osteoporosis,

            ▪           changes in lipid profile.

In patients with a personal or family history of breast cancer and with a personal history of endometrial cancer, careful monitoring should be undertaken.

Subject to specialist advice, hysterectomy and bilateral oophorectomy should be considered after 18-24 months of testosterone treatment, to reduce the possible increased risk of endometrial and ovarian cancer.

 

Continued surveillance is required to detect osteoporosis in patients who have undergone oophorectomy, as testosterone may not fully reverse the decline in bone density in these patients.

 

Continued surveillance is required to detect endometrial and ovarian cancer in patients on long term treatment who have not proceeded to hysterectomy and bilateral oophorectomy.

 

Paediatric population:

In pre-pubertal children statural growth and sexual development should be monitored since androgens in general and Sustanon 250 in high dosages may accelerate epiphyseal closure and sexual maturation.

4.5       Interaction with other medicinal products and other forms of interaction

Enzyme-inducing agents may decrease and enzyme-inhibiting drugs may increase testosterone levels. Therefore, adjustment of the dose of Sustanon 250 may be required.

 

Insulin and other anti-diabetic medicines:

Androgens may improve glucose tolerance and decrease the need for insulin or other anti-diabetic medicines in diabetic patients  subjects (see section 4.4).

Patients with diabetes mellitus should therefore be monitored especially at the beginning or end of treatment and at periodic intervals during Sustanon 250 treatment.

 

Anti-coagulant therapy:

High doses of androgens may enhance the anticoagulant action of coumarin type agents (see section 4.4). Therefore, close monitoring of prothrombin time and if necessary a dose reduction of the anti-coagulant is required during therapy. allowing a reduction of the dose of thee agents (see section 4.4)

 

ACTH or Corticosteroids:

The concurrent administration of testosterone with ACTH or corticosteroids may enhance oedema formation thus these active substances should be administered cautiously, particularly in patients with cardiac or hepatic disease or in patients predisposed to oedema (see section 4.4).

 

 

Laboratory test interactions:

Androgens may Sustanon use may result in decreased levels of thyroxine-binding globulin, resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid hormone levels remain unchanged, and there is no clinical evidence of thyroid dysfunction.

4.6       Fertility, Pregnancy and lactation

 

Sustanon 250 is contra-indicated in women who are pregnant (see section 4.3).

 

Pregnancy:

There are no adequate data for the use of Sustanon 250 in pregnant women. In view of the risk of virilisation of the foetus, Sustanon 250 should not be used during pregnancy (see section 4.3). Treatment with Sustanon should be discontinued when pregnancy occurs.

 

Lactation:

There are no adequate data for the use of Sustanon 250 during lactation. Therefore, Sustanon 250 should not be used during lactation.

 

Fertility:

In men treatment with androgens can lead to fertility disorders by repressing sperm-formation (see section 4.8).

 

In women treatment with androgens can lead to an infrequent or repressed menstrual cycle (see section 4.8).

4.7       Effects on ability to drive and use machines

As faras is known Sustanon 250 has no influence on the ability to drive and use machines. altertness and concentration

4.8       Undesirable effects

Due to the nature of Sustanon 250 side effects cannot be quickly reversed by discontinuing medication. Injectables in general, may cause a local reaction at the injection site.

 

System Organ Class

MedDRA term*

Neoplasms benign, malignant and unspecified (incl. cysts and polyps)

Prostatic cancer1

Blood and lymphatic system disorders

Polycythaemia

Metabolism and nutrition disorders

Fluid retention

Psychiatric disorders

Depression

nNervousness

mMood altered disturbances

lLibido increased

lLibido decreased

Vascular disorders

Hypertension

Gastrointestinal disorders

Nausea

Hepatobiliary disorders

Hepatic function abnormal

Skin and subcutaneous tissue disorders

Pruritus

Acne

Musculoskeletal and connective tissue disorders

Myalgia

Vascular disorders Hypertension
Gastrointestional disorders Nausea
Skin and subcutaneous tissue disorders Pruritus acne

Reproductive system and breast disorders

Ejaculation disorder

gGynaecomastia

oOligozoospermia

pPriapism

Benign prostatic hyperplasia2disorder

Investigations

Hepatic function abnormal LLipids abnormal3

PSA increased

* MedDRA version 15.0

1 Progression of a sub-clinical prostatic cancer

2 Prostatic growth (to eugonadal state)

3 Decrease in serum LDL-C, HDL-C and triglycerides

 

The terms used to describe the undesirable effects above are also meant to include synonyms and related terms.

 

Treatment in women:

Treatment with Sustanon 250 my induce signs of virilisation in women (see section 4.4). Symptoms of virilisation may include hoarseness, acne, hirsutism, menstrual irregularity and alopecia.

Paediatric population:

The following undesirable effects have been reported in prepubertal children boys using androgens in general (see section 4.4): precocious sexual development, an increased frequency of erections, phallic enlargement and premature epiphyseal closure.

 

Updated on 07-May-2014 and displayed until 24-Oct-2014

Reasons for adding or updating:

  • New SPC for eMC ie an SPC for an existing product, but one that is new for the eMC

Legal Category:POM

Black Triangle (CHM): NO

Company contact details

Aspen

Company image
Address

3016 Lake Drive, Citywest Business Campus, Dublin 24, Ireland

Medical Information Direct Line

0800 0087 392

Telephone

+ 44 1748 828 391

Medical Information e-mail

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Active ingredients

testosterone decanoate , testosterone isocaproate, testosterone phenylpropionate, testosterone propionate

Legal categories

POM - Prescription Only Medicine

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